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Small robot makes big difference for cochlear implant patient

Corvallis woman is first person on West Coast to undergo robot-assisted surgery with new device
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Pamela Runner, 77, of Corvallis, Oregon, hears her husband speak through a cochlear implant on Jan. 12, 2024, as her new electronic hearing device is turned on for the first time at Oregon Health & Science University in Portland, Oregon. (OHSU/Franny White)

Pamela Runner, 77, of Corvallis, sat quietly in an Oregon Health & Science University exam room as she waited for the big reveal.

With the click of a computer mouse, OHSU audiologist Jennifer Fowler, Au.D., CCC-A, turned on Pamela’s new cochlear implant for the first time. Fowler pointed to Pamela’s husband of 58 years, Steve Runner, cuing him to break the silence. Before he could speak, Pamela flashed a grin and let out a small, nervous chuckle.

Steve asked, “Hello, Pam. Can you hear me?”

“Yes, I can hear you,” Pamela replied, adding, “It sounds nice.”

On Dec. 21, 2023, Pamela became the first person on the West Coast to have a cochlear implant inserted into her ear with the help of a small surgical robot. Her electronic hearing device was activated three weeks later, on Jan. 12.

Cleared by the Food and Drug Administration in 2021, the iotaSoft Insertion System uses a thumb-sized robot to precisely guide the placement of cochlear implants into the inner ear. The robot-assisted system inserts electrodes about 10 times slower than even the most skilled surgeons. Its ultra-slow insertion has been shown to reduce unintentional damage during surgery and better preserve the inner ear’s tiny, delicate structures.

OHSU is the first institution on the West Coast to use the robot -- the nearest hospital to have used it is in Utah. OHSU surgeons so far have performed three cochlear implant surgeries with the new robotic system, and more are scheduled for the coming weeks. Patients aren’t charged for the robot’s use during cochlear implant surgery; OHSU covers the cost as part of its mission to provide advanced surgical care.

Currently, the best candidates for robot-assisted cochlear implantation are people like Pamela, who still hear some low-frequency sounds, but need help hearing higher frequencies. Early data suggest the robot can help preserve residual hearing and also allow for using a combined cochlear implant and hearing aid in the same ear.

Gradual hearing loss

While Pamela sometimes had difficulty understanding people as a young child, it took a school evaluation at age 17 to understand that she had hearing issues. A medical exam in her mid-20s determined that she had cochlear degenerative disease, which prompted her to start using hearing aids. At work, a special phone that amplified sound helped her hear more clearly.

Jay Gantz, M.D., Ph.D. (OHSU)
Jay Gantz, M.D., Ph.D. (OHSU)

Pamela’s hearing continued to deteriorate as she got older. She learned last year that her left ear’s ability to hear had declined too much for her hearing aid to be helpful. OHSU Cochlear Implant Program surgeon Jay Gantz, M.D., Ph.D., said she was a good candidate for a cochlear implant and that she could receive one with the help of the new robot.

“I was excited,” said Pamela, who had already undergone robot-assisted surgeries for two knee replacements more than a decade ago. “I knew robots can be so much more accurate than humans — I saw that with my knee replacement. When Dr. Gantz told me about the robot, I thought that was fantastic.”

Extremely delicate process

Before Gantz joined OHSU in 2022, he completed a fellowship in neurotology, a medical specialty that focuses on neurological-related inner ear concerns. Gantz was a fellow at the University of Iowa, where the robotic system for cochlear implants was initially developed. He helped lead the system’s first human clinical trial, which found the robot was both safe and effective for cochlear implantation. After he arrived at OHSU, he worked with OHSU leaders to bring the system to Oregon.

“Inserting a cochlear implant electrode into an inner ear is an extremely delicate process,” said Gantz, who is an assistant professor of otolaryngology in the OHSU School of Medicine. “Even very experienced surgeons are at the limit of what they can do with their own dexterity.

“Robot-assisted cochlear implantation is so much slower and more careful,” Gantz added. “It has far less variation in force than the human hand, which can improve outcomes and minimize potential unintentional damage.”

The small robot is temporarily attached to the skull during surgery. Surgeons use a foot pedal to precisely control the speed at which the robot feeds a cochlear implant electrode into the inner ear.

Listening to loved ones

Some cochlear implant recipients initially hear electronic noises when their implant is first activated, but Pamela could immediately hear her husband as she remembered him — and without the hearing aid that she used to have in her left ear.

Gantz and Fowler assured her that was a great sign, but noted her hearing would likely improve slowly. Full recovery from the surgery could take as long as a year. By December 2024, Pamela’s ear should be fully healed, and her brain should learn how to best respond to the device.

To achieve that goal, Pamela has been assigned homework, including practicing listening to sounds with various volumes. In a couple of months, Pamela may be able to get an add-on for her implant: an external hearing aid that attaches directly to, and works in concert with, the cochlear implant. This would amplify the lower-frequency sounds that she can already partly hear on her own.

Pamela appreciates the opportunity to continue listening to her loved ones with the help of a cochlear implant.

“I want to hear everything my husband says,” she said. “Being able to hear the words of my daughter and three grandchildren will also be nice.”

To learn more about cochlear implantation, go to the OHSU Cochlear Implant Program website.

 

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